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When Dr. Bob Prentice, PhD, finished his graduate work in Sociology at Michigan State, he packed up his van and drove to San Francisco. Eventually, he landed in the San Francisco Department of Public Health, where he worked for eighteen years, including a five-year tenure as the Director of the Public Health Division. From there, he co-founded and became the Director of the Bay Area Regional Health Inequities Initiative (BARHII), a collaboration of eleven local health departments in the San Francisco Bay Area and beyond. He also served as Senior Associate for Public Health Policy & Practice at the Public Health Institute. Dr. Prentice’s commitment to re-envisioning public health within a social justice context, including his groundbreaking work expanding public health partnerships into fields like land use, air quality management, and transportation policy, make him a noteworthy public health hero.

Career in Profile

1967 – Completed BA in Social Science, Michigan State University

1972 – Completed MA in Sociology, Michigan State University

1982 – Completed PhD in Sociology, Michigan State University

1988-1991 – Coordinator of Homeless Programs, City and County of San Francisco, Mayor’s Office

Can you talk about a career or success or highlight?

The Bay Area Regional Health Inequities Initiative (BARHII) is a regional collaborative in the San Francisco Bay Area with a mission to transform public health practice to eliminate health inequities and create healthy communities. We started out as a series of conversations between the Public Health Officers and Public Health Directors of three counties (San Francisco, Alameda, and Contra Costa). Back then, we didn’t have the granular data that we have now – I couldn’t have told you that people in Bayiew/Hunters Point (a low-income San Francisco neighborhood) have a 14 year lower life expectancy than people in Russian Hill (an affluent San Francisco neighborhood). But we knew that there wasn’t just a randomness to that, it was tied to other things about those neighborhoods. We were all 60’s activists as well as public health professionals and this was not acceptable.

We now know that 10-15% of that disparity comes from health care. So what accounts for the rest of it? That question opens up the possibility of public health involvement outside the traditional realm of public health programs. BARHII partnered with environmental justice groups to push for improved policies in land use, air quality and public transportation. Those agencies were so used to hearing from the environmental justice groups that their meetings almost felt predictable. But BARHII changed the dynamics because we could argue for changes in public transportation policy by saying, “Unless we do something differently, 1 out of 3 babies born in 2000 will develop diabetes in some point in their life – and closer to 1 out of 2 for African Americans and Latinos.”

Environmental justice and public health both argued for improved public transportation and more stringent air quality targets, but we had different approaches to advancing our positions, which were worked out together prior to public testimony. Because we reframed the debate to include public health, the public officials heard these arguments differently. The air quality management district hadn’t always been sympathetic to environmental justice concerns, but as advocates for public health, they’ve come around.

A decade later, it’s pretty well established that public health has an important role in land use. But that’s just a starting point for all the factors that go into making a neighborhood like Bayview/Hunters Point. What about employment, gentrification, the tax code, public housing? Those are large scale changes over a long period of time, but I think that’s where the field has to go. We’re just getting started here.

What is a persistent challenge that you see in the field?

Ever since the Reagan administration, a strong political current is that our nation’s collective purpose is to minimize the role of government in every aspect of life. Well, except for the military and sex. That’s made it incredibly difficult to work in a public health department. It’s not just the budget. It’s the ability, as a public agency, to move aggressively in a social or political realm. If public opinion wants to minimize the role of government, how do you do that? Take the idea of regulating sugar-sweetened beverages. It’s not just about fast food and obesity, it’s about the fact that a public agency dares to interfere with people’s lives. Tax and regulate sodas? That’s the nanny state!

Unfortunately, that’s the environment we’re working in. My vision of public health means the field needs to be more aggressive about going into new territory, and it’s not even clear that we have permission to do what we’re doing right now. At least in many people’s minds. The real dilemma is that most factors that really influence health are beyond the purview of health departments. We have to learn to work in other people’s territory, and often, we are not welcome. We have to learn how to deal with that strategically!

Do you have any thoughts on what it will take to address this?

We need to have a strong relationship with the community. We need to work with them as allies in a strategic relationship: they contribute their insights from living in the communities, we contribute data or scientific evidence and public health perspectives. We talk to each other. We weigh in with our respective credibility when major decisions come up. We need partners within the community and other departments who can create the opening for public health participation. Whereas if public health tried to walk in on its own, we might not be welcome.

Regional collaboratives like BARHII are also useful. In BARHII, we used to say: if one health department does it, you’ve established a precedent. We understood local political constraints might mean that Alameda County could do certain things that Solano County or San Mateo County couldn’t do – yet – but eventually, we could leverage the regional precedents to establish a new standard of practice. Our perspective was: Go for it! Take it as far as you can! Let us look in on your work, applaud it, and then use your precedent to help all of us claim legitimacy. For example, Alameda County was one of the first health departments to hire community organizers, but that idea is being embraced in other jurisdictions as well. So regional groupings help move beyond local political constraints. They help all participating health departments think strategically about these structural issues.

BARHII’s influence is not just regional. Other jurisdictions, such as Minnesota and West Virginia, are also embracing health equity, so there is a basis for communication on a national scale. Of course, we had a lot of difficulties, it wasn’t a uniform success. But we wanted to influence the field. Not out of organizational egoism, but the longer we’re outliers, the longer it’s difficult to do the work. If more places engaged in similar work, that established legitimacy to our efforts. It’s like that idea of local health departments establishing precedents within BARHII, but on a national scale. More people doing this work means we can push the field even farther.

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